Rachel

Age at interview: 51

Age at diagnosis: 11

Brief Outline:

Rachel has suffered from depression since she was a child although she didn’t seek help until she was around 20. She has been prescribed numerous antidepressants over the years but has found it difficult to cope with side effects and says that antidepressants take away her motivation and vitality.

Background:

Rachel lives with her partner and is currently unable to work because of depression, but she worked as a support worker until fairly recently. She has three adult children. Ethnic background: White British.

More about me...

Rachel had a difficult childhood. Looking back she realises that her depression started when she was very young. She self-harmed in secret for some time and took an overdose of aspirin when she was 11 although she managed to hide it from her parents by pretending she had food poisoning. As an adolescent her parents took her to see the GP because she was very quiet and introverted, and she was given a variety of medicines and vitamins to take. This was in the 1970’s and attitudes and knowledge about mental health were very different from the way things are today. Her problems worsened when she was a teenager. After one particularly serious episode when she cut herself, her parents took her to see a private doctor ‘because of the shame’.... and she was prescribed what she describes as ‘strong medication.... I can’t remember what it was called; my mother kept it in the safe and doled it out to me. I was told by the doctor, who was horrible, that if I didn’t pull myself together in two weeks he would put me in a mental hospital’. After this she began acting up as a teenager, and moved out of home at 17. Now she looks back and sees her behaviour as ‘a cry for help’ but at that time it wasn’t viewed in that way.
 
Her first child was born when she was 19, but the relationship with the child’s father did not last, and she became depressed. She was prescribed what she describes as strong medication that made her feel out of control and not ‘herself’.
‘I don’t like anything that makes it feel like it’s stronger than my head that does that fight thing with it. it is like when they put you under anaesthetic to have an operation that, it’s losing control so I wasn’t, I wasn’t on them for very long.’
 
She went on to have two more children, and remembers that after each one she felt low and depressed but didn’t seek help, not realising there was help available. The relationship with their father broke down and life became a struggle; she lost her job and wasn’t able to cope. This was the first point at which she went to see the GP for help, and was initially prescribed Seroxat (paroxetine). This antidepressant was of some help to her, as at the time she was barely able to function, bringing up her children had become very difficult; some days she could barely get out of bed. She took Seroxat (paroxetine) for around 18 months, and also had therapy. After around 3 months she began to feel an improvement in mood, and after about a year life started to feel more manageable. She stayed on the antidepressant despite side effects – rapid weight gain, and a feeling that she wasn’t able to be her ‘true self’. On it she said she felt she had lost her sense of motivation and creativity and was just functioning. After a year or so she felt herself slipping back to depression again, and that the antidepressant was losing its effectiveness.
 
Over the years Rachel has been prescribed several different antidepressants including citalopram, doxepin, venlafaxine, fluoxetine, and has also taken diazepam for anxiety. She has sometimes stopped taking them of her own accord because of side effects.
 ‘They’ve all given me side effects and in some places more or less of fairly similar ones. which are putting on weight, losing appetite and sleep disturbance terribly….It’s very hard to separate what belongs in the fact that, you know, you’re suffering from or recovering from a severe episode of depression and what is the, what is the medication.’
 
There have been a few times when Rachel has felt like giving up and contemplated taking her own life, but having children has kept her going and she says suicidal thoughts are about wanting the bad feelings to stop. She recently had a particularly bad episode which culminated in her being referred to the local mental health crisis team for a few weeks. Over the years she has seen a variety of health professionals including CPN’s, GP’s, psychiatrists and psychologists. Some of the strategies and help she has received have been helpful, but at times she has found it frustrating and difficult because she has felt patronised and disempowered. The mental health team she is currently under ‘have a whole team approach so you see the CPN and the psychiatrist and I asked to see a psychologist because I’d been reading stuff and it’s slowly getting accepted that medication isn’t the be all and end all and that people can be greatly helped with psychological therapies’.
 
Rachel is currently taking Prozac (fluoxetine) even though she doesn’t like how antidepressants make her feel. ‘I feel like the version of ‘me' on medication isn’t the ‘me’ I want to be .... I’m a creative person, I make art and write poetry....they lift you off the bottom where you’re suicidal, but they shave so much of the motivation and limit how much joy you can experience in your life. You’re making it through the day, but you’re not expressing yourself.’ 

Rachel described the patient information leaflet as ‘frightening’...

I do ask as well because of the frightening leaflet, you know, I’ve had it where I’ve come home with something and then you read, you read the leaflet and then I haven’t taken them because it sounds so scary.
 
Right, what kind of things would it say that would scare you?
 
Well it seems to repeat the symptoms of what you’re suffering from already.......’you may feel suicidal’ or you think oh my God, you know.
 
It’s meant to stop me from feeling.....that?
 
Yes and I mean I again it’s something I try not do because, but I’m not always strong willed and I because I it’s almost like I, I sometimes think I kind of use it because then I can justify my lack of interest in taking it, ‘wow look at all these contraindications’
 
Can’t take that.
 
Yes so but pretend you know I’m quite good at, you know, stocking up my reasons why I can’t do.

Rachel has mixed feelings about taking the various different...

Technically it did help because it did, because it was about, it felt like forever but the really sort of down serious point was for probably about three months and then it took at least a year to come back up to a managing level and I was good I stuck on the medication but the things that still troubled me about them where there. I mean I put on about three stone in weight rapidly…
 
I felt because I’m quite a creative person I make art and write poetry and stuff like that and yes they, they lift you off the very bottom where you’re suicidal but they shave off so much of the motivation and the, the for creativity they limit how much joy you can experience in your life. Because you just don’t have it it’s, you can’t feel things in the same way and for me it didn’t, you know, it certainly is the big, big thing for me is that I’ve always had this weighing up between having highs and lows but being able to experience those highs and living in this what I’d sort of call like middle of the road grey area.

Rachel explains how difficult it is to know how much the...

I think that is very, very misunderstood or we even just not knowing about how physical an illness depression can be, how physically ill you can feel, you know you do have aches and pains you do you know have nausea, you do have more headaches, you do have just, you know, shakes and stuff like that you do wake up with your, with your jaw stiff because you’ve been clenching, you wake up with your knuckles white and your hands aching so much because you’ve been so tense or whatever.
 
They’ve all given me side effects and in some places more or less of fairly similar ones. which are putting on weight, losing appetite and sleep disturbance terribly, I mean I do get insomnia anyway but I just can’t sleep and I can’t sort of, I can’t establish a pattern of sleeping and incredibly vivid dreams.
 
Is that side effect from your medication?
 
I think, well this is one of the big things which is very, very confusing and I was saying to my CPN yesterday that it’s very hard to separate what belongs in the fact that, you know, you’re suffering from or recovering from a severe episode of depression and what, what is the, what is the medication. but the things I’m saying are things that have happened and persist, persist in happening even when I might still be depressed but I’m over that real crisis period and, you know, they’ve had, they’ve had their two weeks or three weeks or whatever it is to work and there are some things which like putting on weight, loss of, loss of well not, not loss of interest in things like sex and you’re libido but a lack of being able to feel.
 
I mean three times I’ve set fire to the kitchen just I forgot, I forgot I was cooking. I mean and I don’t know how much of that is, is depression but some of it is definitely the medication. This sort of memory loss all this distraction, inability to stay on point.

Rachel has tried herbal remedies when she has been ‘in...

Have you taken any over the counter remedies or anything like that?
 
St John’s Wort.
 
And how do you find that, you’re not meant to take that if you’re taking?
 
No, I take that particularly when they first started sort of going St John’s Wort works for moderate depression you know, mild to moderate depression. and I did, I did I thought it was, I thought it was okay as and I also… sort of things like in between other medications, I’ve had things like Quiet Life tablets and stuff like that and natural remedies.
 
Do you feel that there is an effect from those?
 
I think so, I think so yes. I mean particularly things that, you know, with the ones which have got valerian in and hops those things definitely have a soporific effect and sometimes…. but in quite a gentle way which I can cope with. Because if something it’s not very magical but if something makes you, makes you a bit more sort of sleepy and laid back, you can’t physically be so anxious. I mean they help more with anxiety than depression.

Rachel has very mixed feelings about using an antidepressant

I’ve got a very, a very you know it’s not even a love- hate relationship with anti-depressants, I’ve got mainly a ‘hate’ in as much as I know that there are times where, where I have to take them and I have to try really hard to be very good and stay on them and stuff until I’m better but I really struggle with them as I say a lot because of the side effects.
 
I feel like the version of me is on medication it isn’t ‘me’. It isn’t the ‘me’ I want, I want to be because it shaves too many bits off you.
 
Right.
 
So.
 
So if you, say you were kind of put on maintenance dose, you know a low dose and told just keep taking that would that be good for you or not?
 
Well I’ve tried it, I realise it is my, I don’t like being, I don’t like being dependent on them.
 
So you’d rather get to the point where you can stop taking them and you have a period where?
 
Yes I’d rather, I’d rather have periods where I wasn’t taking them but this is what, you know, the, but on the other hand and this is, this is my big dilemma now because I feel some days, you know, more than others but I particularly feel like I don’t want to waste anymore of my life on this bloody thing, you know, it seems it takes, it takes so much out and your sort of output into life is so limited, you know, because you’re drained.
 
So the ultimate goal is for the depression to disappear?
 
Yes.
 
I mean do you in terms of sort of your thinking about the future do you expect that might happen or is that something that?
 
Well I hope to have, I mean I know I’m always going to be a person who, who does this I always have been and they, you know, there are people who manage on much sort of flatter parts because it’s how they are but it’s not me.

Rachel felt the psychiatrist was too focused on diagnosis and...

The psychiatrist will ask about your symptoms and he’ll then look in his book and see what tablets he can send you away with. I mean I’ve even had where it’s got to quite heated discussions with them, you know, and them trying to do a deal with me like well can we at least put down that if, you will go to the GP and have these, if you feel worse.
 
Do you feel that that’s the sort of, there’s a joint decision making process going on between you and, when you see a psychiatrist or is it more like it’s being done to you?
 
It’s more like being done to me particularly with the psychiatrist because it’s a bit like that thing with consultants in a hospital or whatever, you know, he or she, I’ve always had ‘he’ psychiatrists that you know they’re the sort of the God on high, the head of the tier of the hierarchy and you know just the whole atmosphere. I mean it might, I may be a little biased because I have yet to have a psychiatrist tell me anything that I have found particularly useful in getting better. And that might sound rather arrogant but it’s not, it’s ….I respond much better to people who let me tell them ‘this is how I feel’ it might not go into a little box, some things do I mean obviously there’s but some things are just about how, how you feel and it’s really.
 
It’s very individual isn’t it?
 
Yes and it’s very presumptuous of somebody else, you can have all the training in the world but you’ve got to be able to, instead of trying to fit everybody into a neat little box and, you know and there’s time restrains and everything else they’ve got so many people to see in a certain time and, you know, I get that but there’s not always the time to give people the individual attention that perhaps they’d need.

Rachel has been referred to the community mental health team several times...

When an episode has, when an episode has started the familiar, the sort of routine seems to be that I take heed or not very much of the fact that I think I’m slipping in that way, I have tried to intervene sometimes and gone to the GP sooner. I’ve then had a referral to the, I mean initially I must have just been referred but now, I mean they tend to think I think oh it’s Rachel - we’ll put her back in touch with the mental health team and part of that is because they have a whole team approach so you see the CPN of the psychiatrist and I asked for the psychologist because I’d been sort of looking into it and reading stuff and it apparently it’s slowly getting accepted that medication isn’t the be all and end all that people can be greatly helped with psychological therapies. And so I basically asked for it and kept on, kept on saying to anybody who’d listen, you know, to the CPN I was put with and the psychiatrist and stuff like that. I was saying I feel that seeing a psychologist would be really good because, because I’d rather have strategies to cope than, than medication and no strategies.
 
So what’s the difference then would you say between going to see a psychiatrist and seeing a psychologist?
 
Psychiatrists are very clinical and their answer is virtually always medication.